Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' a z l ^ DEVELOPMENT SERVICES PERMIT #: ELR2005 -00324
' II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/6/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09378 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: HVAC low voltage.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE LLC LORENZ ELECTRICAL CONSTRUCTION INC
BY THE MACERICH COMPANY 2074 NW ALOCLEK DRIVE SUITE 41
9585 SW WASHINGTON SQUARE RD HILLSBORO, OR 97124
TIGARD, OR 97223
Phone: Phone: 503 614 - 0400
Reg #: LIC 138608
ELE 34 -516C
FEES SUP 4673S
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 10/6/2005 $75.00
[TAX] 8% State Surcharl 10/6/2005 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952- 01 -0 00. You may obtain copies of these rules or dire question 'c,sO NC at 503 - 246 -6699.
Issued By: Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 503 -639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Apt ' on FOR OFFICE LSE ONLY
City of Tigard I E ® Received , 05 9 i Pemut Nor j • I r_�3A
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.6394171 Fax 503.598.1960 0 6 200 4'� elB : Other Permit
Inspection Line: 503.639.4175 vv 0 6 J ! (A,� _ Date Ready/By UM ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method Supplemental Information
CITY Or TIC RD
h ION PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ['Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION . of 1- and 2- family dwellings 4 or more new residential
❑ I- and 2- family dwelling E Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi - family ❑Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION 0 Egress/lighting plan RV park
Job no.: I Job site address: 9378 SW WASHINGTON SQUARE RD ❑Health care facility :Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: TIGARD, OREGON The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: 1 Project name: DUCK SHOP
Description I Qty. Ree Total
Cross street/directions to job site: New residential single - or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea add'! 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
LOW VOLTAGE (1) HVAC SYSTEM dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER . I ® TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: DUCK SHOP 601 amps to 1,000 amps 240.60 2
Address: 9378 SW WASHINGTON SQUARE ROAD Over 1,000 amps or volts 454.65 2
Reconnect only 66 85 2
City/State/ZIP: TIGARD, OREGON Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
CO APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: ACCURATE HEATING branch circuit 6.65 2
B. Fee for branch circuits
Contact name: MICHAEL BLACKMON JR without service or feeder fee,
each branch circuit 46.85 2
Address: PO BOX 2276 Each addi branch circuit 6.65 2
City/State /ZIP: CLACKAMAS, OREGON Miscellaneous (service or feeder not included)
P or irrigation circle 53.40 2
Phone: (503) 650.1229 I Fax: : (503) 650.4845
Sign or outline lighting 53.40 2
E -mail: MBLACKMONJR@ACCURATEHEATING.COM Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: LORENZ ELECTRICAL CONTRACTOR
Address: 2074 NW ALOCLEK SUITE 42 Each additional inspection over allowable in any of the above
Per inspection i 62.50
City/State/ZIP: HILLSBORO, OREGON Investigation per hour (I hr min) 62.50
Phone: (503) 614.0400 I Fax: (503) 614.0401 Industrial plant per hour - 73.75
ELECTRICAL PERMIT FEES*
CCB Lie.: 138608 I Electrical Lie.: 34 -516C I Suprv. Lie.: 4673S Subtotal 1 S" •
Suprv. Electrician signature, required: / Il bli Plan review (25 %of permit fee)
State surcharge (8% of permit fee)
Print name: '"J v ^ l Date: 10.01.05 i
t37 7
�� 1 L t y TOTAL PERMIT FEE . 0 0
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri -County Building Industry Service Board
•• Number of inspections per permit allowed
i \BwldmgWemuts\ELC- PermitApp doe 12/03 440.4615T(10/02/COM/WEB
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00324
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/6/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 I L
INSPECTION WORKSHEET FOR DATE: 11/14/2005 TIME: 7:12AM PAGE: 05
SITE ADDRESS: 09378 SW WASHI JON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SOU - E LOT #: TYPE OF USE:
PROJECT NAME: DUCK SHOP
DESCRIPTION: HVAC low voltage.
OWNER: WASHINGTON SQUARE LLk PHONE #:
CONTRACTOR: LORENZ ELECTRICAL CONS RUCTION INC PHONE #: 503 - 614 -0400
Inspection Request Scheduled For: D.k e: 11/14/2005 Pour Time: •
Code # Inspection Description Confi # Contact # Message
02110 12 503 -317 -3007 N
•
Corrections /Comments /Instr - tions:
• \
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: • / . Date: II • PI. Phone #: (503) 71 214q1'